Magnetism and the Nursing Workforce
Magnetism and the Nursing Workforce

The focus of this chapter is to highlight practice exemplars and research fi ndings

related to the fi ve components of the new Magnet Model®. A brief overview of

the historical development and professional evolution of the American Nurses

Credentialing Center (ANCC) Magnet Recognition Program® is presented followed

by a brief overview of the original fourteen forces of magnetism. Content

related to empirical practice-based research framed under the components of

transformational leadership; structural empowerment; exemplary professional

practice; new knowledge, innovation, and improvement; and empirical outcomes

is presented and discussed. The authors provide key fi ndings from scholarly

publications and describe how the fi ndings contribute to the creation of

work environments based on the tenets of magnetism. The chapter concludes

with a brief over of the ANCC Pathway to Excellence Program®.

In her September 1980 Presidential address to the American Academy of Nursing

(AAN), Linda Aiken articulated the scope of the nursing shortage; over 80% of

American Hospitals do not have the adequate staffi ng with some 100,000 vacancies

in hospital nursing positions, which is having a crippling effect on dayto-day

operations (AAN, 1983; ANA, 2010 reissue). In order to identify ways to

Magnetism and the Nursing Workforce

help solve this problem, the Governing Council of the AAN appointed a Task

Force on Nursing Practice to examine the characteristics of systems facilitating

professional practice in hospitals (McClure, Poulin, Sovie, & Wandelt, 2002).

Selected AAN Fellows were asked to nominate potential Magnet hospitals that

demonstrated success in recruiting and retaining professional nurses on their

staffs (AAN, 1983; ANA, 2010 reissue).

Out of the 165 hospitals nominated, 46 were selected with 41 participating.

Five of the nominated hospitals were unable to participate because of scheduling

problems. A staff nurse representative along with the director of nursing

engaged in separate group interviews and articulated their concepts of the conditions

that made their hospital a good place to work. The 14 Forces of Magnetism

evolved from this original Magnet Study. Aiken’s (1994) study demonstrated

lower Medicare mortality in Magnet Hospitals. Aiken, Havens, and Sloane’s

(2009) research documented that American Nurses Credentialing Center (ANCC)

Magnet hospital designation is a valid marker of good nursing care. An associated

energy is created in nurses of Magnet-designated facilities as a forum for nursing

staff to showcase their work is created, resulting in a great deal of organizational

pride (Horstman et al., 2006). The following is a brief overview of the original 14

Forces of Magnetism as defi ned by the ANCC (2005, 2008a, 2008b).

Force 1. Quality of Nursing Leadership: Knowledgeable, strong, risk-taking

nurse leaders follow a well-articulated, strategic, and visionary philosophy in the

day-to-day operations of the nursing services. Nursing leaders, at all levels of the

organization, convey a strong sense of advocacy and support for the staff and for

the patient. The results of quality leadership are evident in the nursing practice at

the patient’s side (ANCC Magnet Recognition Program, 2005). Drenkard (2005)

indicated that the chief nurse offi cer (CNO)must be the role model for living the

concepts in the Magnet Forces.

Force 2. Organizational Structure: Organizational structures are generally

fl at, rather than vertical, and decentralized decision-making prevails. The organizational

structure is dynamic and responsive to change. Strong nursing representation

is evident in the organizational committee structure. Executive-level

nursing leaders serve at the executive level of the organization. The CNO typically

reports directly to CNO. The organization has a functioning and productive

system of shared decision-making (ANCC Magnet Recognition Program,

2005). Batcheller (2010) noted that the CNO’s tenure is affected when there is

a confl ict with the chief executive offi cer and that the challenge nurse leaders

face are to develop a competency model and roadmap in becoming transformational

leaders.

Force 3. Management Style: Health care organization and nursing leaders

create an environment supporting participation. Feedback is encouraged and

valued and is incorporated from the staff at all levels of the organization. Nursing

serving in leadership positions are visible, accessible, and committed to communicating

effectively with staff (ANCC Magnet Recognition Program, 2005).

Caroselli (2008) stressed that although the role of the chief nurse executive was

complex, daunting, risk-laden, it provided unprecedented opportunities to infl uence

the care of patents in a very broad context.

Force 4. Personnel Policies and Programs: Salaries and benefi ts are competitive.

Creative and fl exible staffi ng models that support a safe and healthy work

environment are used. Personnel policies are created with direct care nurse

involvement. Signifi cant opportunities for professional growth exist in administrative

and clinical tracks. Personnel policies and programs support professional

nursing practice, work/life balance, and the delivery of quality care (ANCC

Magnet Recognition Program, 2005). Laschinger, Finegan, Shamian, and Wilk

(2001) identifi ed that by linking structural empowerment with psychological

empowerment, employees’ emotional connectedness with the work setting were

positively infl uenced. Jasovsky et al. (2005) reported on a cost-effective on-line

system for collecting the demographic data for the Magnet monitoring reports.

Force 5. Professional Models of Care: There are models of care that give nurses

the responsibility and authority for the provision of direct patient care. Nurses

are accountable for their own practice as well as the coordination of care. The

models of care (i.e., primary nursing, case management, family-centered, district,

and holistic) provide for the continuity of care across the continuum. The models

take into consideration patients’ unique needs and provide skilled nurses and

adequate resources to accomplish desired outcomes (ANCC Magnet Recognition

Program, 2005). Wolf and Greenhouse (2007) believed that successful transformation

and integration of a care delivery model into the DNA of the organization

must be led by the CNO with unrelenting passion. The model should serve as the

foundation for assessment, planning, organizing, job description, a reward and

recognition system, recruitment, staff development and research.

Force 6. Quality of Care: Quality is the systematic driving force for nursing

and the organization. Nurses serving in leadership positions are responsible for

providing an environment that positively infl uences patient outcomes. There

is a pervasive perception among nurses that they provide high-quality care to

patients (ANCC Magnet Recognition Program, 2005). Magnet hospital nurses

always rate the essential element of ‘working with other nurses who are clinically

competent” as “important” for quality of care and “present” in Magnet

hospitals. Magnet hospital staff consider specialty certifi cation, advanced

education, and both formal and informal peer review as evidence of clinical

competency (Kramer & Schmalenberg, 2004). Gawlinski (2007) stressed that

outcome variables should be measured before (at baseline) and after the practice
change. Measurement at these time points allows comparison and evaluation of

the effects of practice change. The sustainability of the practice change can also

be evaluated by measuring the process and outcome variables 6–12 months

after implementation.

Force 7. Quality Improvement: The organization has structures and processes

for the measurement if quality and programs for improving the quality of

care and services within the organization (ANCC Magnet Recognition Program,

2005). Hinshaw (2006) reported that translating the Institute of Medicine’s

recommendations, Keeping Patient Safe: Transforming the Work Environment of

Nurses into practice required an extensive collaboration among nurse administrators

and nurse researchers to advance the quality of care. This was supported

by Kramer and Schmalenberg (2005) who reported that the Magnet

Recognition Program stimulated valuable and insightful research related to

outcomes since staff nurses identifi ed process/functions most essential to quality

patient care.

Force 8. Consultation and Resources: The health care organization provides

adequate resources, support, and opportunities for the utilization of experts,

particularly advanced practice nurses. In addition, the organization promotes

involvement of nurses in professional organizations and among peers in the community

(ANCC Magnet Recognition Program, 2005). Evidence-based practice

for advanced practice nurses incorporates critical thinking, accessing research

resources, using evidence-based tools such as clinical practice guidelines and

implementing the recommendations into clinical practice (Kleinpell & Gawlinski,

2005; Kleinpell, Gawlinski, & Burns, 2006).

Force 9. Autonomy: Autonomous nursing care is the ability of a nurse to

assess and provide nursing actions as appropriate for patient care based on

competence, professional expertise, and knowledge. The nurse is expected to

practice autonomously, consistent with professional standards. Independent

judgment is expected to be exercised within the context of their interdisciplinary

and multidisciplinary approaches to patient/resident/client care (ANCC Magnet

Recognition Program, 2005). Magnet hospitals have demonstrated better patient

outcomes, safer patient care, increased autonomy and greater nurse satisfaction

through mentoring programs (Fundeburk, 2008).

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